We had a claim for post pay review which took place Nov 1 -Nov 10.This patient was on
rehab,then Omra due to acute renal failure[ref dialysis,96 yrs of age.I won't go into
the particulars because I was too busy to investigate after Bus office called me.The
patient went on inpatient hospice on Nov 11th.The FI denied claim,not reasonable and
necessary.This has never happened to me ,what is our appeal process?I seem to remember
that the facility Adminis needs to write a letter requesting reconsideration.They,I
think would ask for documentation as to why we feel we have a valid claim.Anyone have
this happen recently.My FI is Mutual of Omaha.It is easy to beat yourself over a lost
claim.
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